Dr. Caroline Robins:

I will give the Senator an example. If a private patient has a problem, we can talk about what needs to be done and get on with it straight away. If a patient with a medical card has a problem, the first thing I need to do is go to my computer and go to the relevant part of the health checker to see if I can actually do that filling on the patient because if he or she has had that filling done here or elsewhere within the past five years, I am not entitled to do that filling for him or her.

If the patient will not pay for it I am then faced with telling the patient "I am very sorry, you are not going to pay for it so I now have to send for approval, so that is a bit of a wasted appointment for you. I am very sorry you are in pain and that it is uncomfortable, but my hands are tied. I am not actually allowed to do the filling for you until that approval comes back." That is just an example. If I am filling in forms at the end and I go to claim a tooth extraction, and if I get told on the form that the tooth had previously been extracted, which can happen through a charting mismatch, I must write to the chief dental officer with all of the X-rays and the patient's files to ask the HSE to alter its file at the central hub, and then wait for that to get recognised at the primary care reimbursement service, PCRS. Then I must try to claim again. It is a very clunky system and it takes a lot of time. This is just to give the committee a basic idea.